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Rotator Cuff Disease Follow-up

  • Author: André Roy, MD, FRCPC; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Apr 21, 2016
 

Further Outpatient Care

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  • A follow-up visit should be scheduled 6-8 weeks following the initial evaluation. During this time period, prescribed tests should have been performed and results received. Effectiveness of the initial treatment should be assessed and, if necessary, modifications made.
  • Following visits depend on the responsiveness to the treatment. Recommend 2 months of follow-up visits until the condition has improved or stabilized.
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Deterrence

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  • No medication or homeopathic agent is known to prevent tendon degeneration.
  • Avoidance of highly repetitive activities or sustained shoulder posture with greater than 60° of flexion or abduction is probably the best prevention.
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Patient Education

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Contributor Information and Disclosures
Author

André Roy, MD, FRCPC Consulting Staff, Department of Physiatry, Montreal University Hospital Center and Montreal Rehabilitation Institute

André Roy, MD, FRCPC is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Thierry HM Adahan, MD LMCC, CCFP, FRCPC, FABPMR, Head, Pain Rehabilitation Center, Haim Sheba Medical Center, Tel Hashomer, Israel

Thierry HM Adahan, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Benjamin Dahan University of Montreal, Canada

Disclosure: Nothing to disclose.

Manon Bélair, MS Consulting Staff, Hospital Notre-Dame, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

References
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Normal plain radiograph of the shoulder in internal, external, and neutral positions.
Subchondral sclerosis of the humeral head as seen in chronic tendinopathy.
Calcification at the insertion of the rotator cuff, another sign of chronic tendinopathy.
Presence of a bony spur on the inferior surface of the acromion.
Superior migration of the humeral head in chronic, complete rotator cuff tear. Note the reduced space between the acromion and the humeral head.
Normal double-contrast arthrography of the shoulder.
This image depicts the channel between the articular capsule and the subacromial-subdeltoid bursa in a complete rotator cuff tear.
Even if the channel cannot be always identified, the presence of contrast medium in the subdeltoid-subacromial bursa signs the presence of a complete rotator cuff tear.
Complete rotator cuff tear with presence of contrast medium in the subacromial-subdeltoid bursa. Also note the multiple irregularities in the synovial fluid showed as multiples filling defects.
Computed tomography (CT)-arthrography scan of the shoulder in the axial plane. Note the presence of air and contrast in the subacromial-subdeltoid bursa.
Full-thickness tear of the supraspinatus seen as a hyperintensity line through the full thickness of the tendon (as viewed in a flash 2-dimensional magnetic resonance imaging [MRI] sequence in the coronal oblique plane).
Slight hyperintensity signal within the tendon without transsectional hyperintensity throughout the tendon is compatible with tendinopathy without complete tear. Additionally, note the presence of the hyperintensity signal in the region of the subdeltoid-subacromial bursa, which indicates bursitis.
Calcifications are seen as hypointense foci in flash 2-dimensional.
Arthro–magnetic resonance imaging (MRI) can help to identify labral tears, as seen in this image. The contrast medium penetrates between the labrum and the articular surface.
Ultrasonography is another modality that can demonstrate a complete rotator cuff tear. This image reveals a gap of more than 2 cm between both extremities of the torn tendon.
Table 1: Radiological Findings on Plain Film
 TendinitisPartial TearComplete Tear
NormalXXX
Soft tissue calcification(s)XXX
Greater tuberosity flattening or hypertrophyXXX
Humeral head cystsXXX
Acromial sclerosisXXX
Acromial spursXXX
Acromion type 2 and 3XXX
Acromioclavicular osteoarthritisXXX
Upward migration of humeral head ( < 6 mm)  X
Table 2: Radiological Findings on MRI
TendonsSoft tissuesBone structures
Thickening of rotator cuff tendon (RCT)Intra-articular effusionGreater tuberosity flattening or hypertrophy
Grey signal intensity within the RCTSubacromial-subdeltoid bursal effusionHumeral head cysts
Fluid-filled gap across the tendonMuscle atrophyAcromial sclerosis
RetractionThickening of coracoacromial ligamentAnterior acromial spur
Grey signal intensity in the long head of biceps tendon Acromion type 2 and 3



Acromioclavicular osteoarthritis



Rupture of the long head of the biceps tendon Upward migration of humeral head



Os acromiale



Calcifications in the supraspinatus, infraspinatus or teres minor Bone edema
Table 3: Radiological Signs of Specific Disorders
 TendinitisPartial TearComplete Tear
Thickening of RCTXX 
Grey signal intensity within the RCTXX 
High signal intensity crossing only 1 surface of the tendon X 
Fluid-filled gap across the tendon  X
Retraction  X
Grey signal intensity in the long head of the biceps tendonXXX
Rupture of the long head of the biceps tendonXXX
Calcifications in the supraspinatus, infraspinatus or teres minor tendonXXX
Intra-articular effusionXXX
Subacromial-subdeltoid bursa effusion   
Muscular atrophy  X
Thickening of coracoacromial ligamentXXX
Greater tuberosity flattening or hyper-trophyXXX
Humeral head cystsXXX
Acromial sclerosisXXX
Anterior acromial spurXXX
Acromion type 2 and 3 XX
Acromio-clavicular osteoarthritisXXX
Upward migration of humeral head  X
Table 4: Ultrasonographic Signs of Rotator Cuff Disease
Primary signsAccessory findings
Focal interruption of tendonRetraction of the muscle
Presence of fluid in the gapSynovial cysts in the humeral head
Lost of convexity of the tendon and bursaHyperechoic foci + shadowing (calcium)
Uncovered cartilage signFluid effusion in the bursa
Diffusely hypoechoic tendon articulationFluid effusion in the Ganglion cysts
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